ArticlePain2021
A picture is worth a thousand words: linking fibromyalgia pain widespreadness from digital pain drawings with pain catastrophizing and brain cross-network connectivity.
Article in Pain, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Seed-based resting-state connectivity as a neurosignature in fibromyalgia and depression: a narrative systematic review.Frontiers in human neuroscience · 2025Pooled it
- The use of abstract animations and a graphical body image for assessing pain outcomes among adults with sickle cell disease.The journal of pain · 2025Trial
- Telehealth-delivered cognitive behavioral therapy - a potential solution to improve sleep quality and normalize the salience network in fibromyalgia: a pilot randomized trial.Brain imaging and behavior · 2024Trial
- A Randomized Controlled Neuroimaging Trial of Cognitive Behavioral Therapy for Fibromyalgia Pain.Arthritis & rheumatology (Hoboken, N.J.) · 2024Trial
- Prediction of Differential Pharmacologic Response in Chronic Pain Using Functional Neuroimaging Biomarkers and a Support Vector Machine Algorithm: An Exploratory Study.Arthritis & rheumatology (Hoboken, N.J.) · 2021Trial
- In the End: Associations Between Sleep Disturbance and Functional Impairment in Fibromyalgia-A Path Analysis Study.Journal of sleep research · 2026Article
- Transcranial Alternating Current Stimulation for Pain: Mixed Evidence and the Path to Precision Neuromodulation.Brain sciences · 2026Review
- Proportion of Myofascial Pain Syndrome Among Patients with Diagnosed or Suspected Fibromyalgia: A Pilot Cross-Sectional Study.Journal of pain research · 2026Article
- The Impact of Catastrophization and Emotions on Pain: A Narrative Review of Underlying Mechanisms.Journal of pain research · 2026Review
- Pain Catastrophizing: Mechanisms and Clinical Implications.Journal of pain research · 2026Review
- The emergence of sex differences in primary pain during adolescence: a conceptual developmentally-oriented biopsychosocial model and opportunities for further investigation.BMC pediatrics · 2025Review
- Summary and Analysis of Digital Pain Manikin Data in Adults With Pain Experience: Scoping Review.Journal of medical Internet research · 2025Article
- Brain structural differences between fibromyalgia patients and healthy control subjects: a source-based morphometric study.Scientific reports · 2025Article
- The Effect of Combining Transcranial Direct Current Stimulation and Pain Neuroscience Education in Patients With Chronic Low Back Pain and High Pain Catastrophizing: An Exploratory Clinical, Cognitive, and fMRI Study.Brain and behavior · 2025Article
- How does chronic psychosocial distress induce pain? Focus on neuroinflammation and neuroplasticity changes.Brain, behavior, & immunity - health · 2025Article
- Article
- Pharmacological Treatment of Fibromyalgia Syndrome: A Practice-Based Review.Current pain and headache reports · 2024Review
- Deciphering nociplastic pain: clinical features, risk factors and potential mechanisms.Nature reviews. Neurology · 2024Review
- Functional connectivity associated with attention networks differs among subgroups of fibromyalgia patients: an observational case-control study.Scientific reports · 2024Observational
- Broadening the Scope of Resilience in Chronic Pain: Methods, Social Context, and Development.Current rheumatology reports · 2024Review
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
abstractPain catastrophizing is prominent in chronic pain conditions such as fibromyalgia and has been proposed to contribute to the development of pain widespreadness. However, the brain mechanisms responsible for this association are unknown. We hypothesized that increased resting salience network (SLN) connectivity to nodes of the default mode network (DMN), representing previously reported pain-linked cross-network enmeshment, would be associated with increased pain catastrophizing and widespreadness across body sites. We applied functional magnetic resonance imaging (fMRI) and digital pain drawings (free-hand drawing over a body outline, analyzed using conventional software for multivoxel fMRI analysis) to investigate precisely quantified measures of pain widespreadness and the associations between pain catastrophizing (Pain Catastrophizing Scale), resting brain network connectivity (Dual-regression Independent Component Analysis, 6-minute multiband accelerated fMRI), and pain widespreadness in fibromyalgia patients (N = 79). Fibromyalgia patients reported pain in multiple body areas (most frequently the spinal region, from the lower back to the neck), with moderately high pain widespreadness (mean ± SD: 26.1 ± 24.1% of total body area), and high pain catastrophizing scale scores (27.0 ± 21.9, scale range: 0-52), which were positively correlated (r = 0.26, P = 0.02). A whole-brain regression analysis focused on SLN connectivity indicated that pain widespreadness was also positively associated with SLN connectivity to the posterior cingulate cortex, a key node of the DMN. Moreover, we found that SLN-posterior cingulate cortex connectivity statistically mediated the association between pain catastrophizing and pain widespreadness (P = 0.01). In conclusion, we identified a putative brain mechanism underpinning the association between greater pain catastrophizing and a larger spatial extent of body pain in fibromyalgia, implicating a role for brain SLN-DMN cross-network enmeshment in mediating this association.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.